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Safety: Dry Needling and Acupuncture

The excellent safety record of Licensed Acupuncturists is part of our “brand” and has been a focus in the fight against the use of filiform needles by those without our extensive training.

Are we walking our talk?

At a recent professional gathering a representative of a malpractice insurance company recited a terrifying list of problems that turned into insurance claims against acupuncturists: a double pneumothorax, infections from needles manufactured in unsterile conditions, broken bones from tui na, burns from heat lamps. The message – Buy Malpractice Insurance!

On Facebook, Acupuncturists regularly look for support after a patient reports a post-treatment issue.The equivocations quickly pour in: Is that really where you needled? Are they on medication? It’s a healing reaction. Did you have them sign a waiver? There is such a thing as a spontaneous pneumothorax….

Yes. Malpractice insurance is a good idea. And sometimes post-treatment issues aren’t treatment related. But the lack of concern about the problems, and the lack of interest in how they might be avoided, calls into question our supposed devotion to public safety. Not only are we advised to never admit responsibility to our patients, we’re encouraged to never admit it to ourselves.

“The committee’s approach was to emphasize that “error” that resulted in patient harm was not a property of health care professionals’ competence, good intentions, or hard work. Rather, the safety of care—defined as “freedom from accidental injury”3 (p. 16)—is a property of a system of care, whether a hospital, primary care clinic, nursing home, retail pharmacy, or home care, in which specific attention is given to ensuring that well-designed processes of care prevent, recognize, and quickly recover from errors so that patients are not harmed.”

Lisa Rohleder writes –

“It’s impossible to effectively promote safety when we don’t know where WE are going wrong. An important part of developing a culture of safety is to establish, as much as possible, a compassionate, neutral, and curious attitude toward safety errors and adverse events. Nobody wants to make an error (either large or small) or have a patient suffer an adverse event — and yet anybody who practices acupuncture for long enough will experience those things. Acupuncture is a practice that involves humans on both ends of the needle, which means sometimes, unfortunately, things will go wrong.”

“Acupuncture legislation and regulation are not the same as creating a culture of safety. Training cannot ensure that the people who receive it will never play a role in an adverse event. A culture of safety requires an active, ongoing, self-reflective, cooperative process.”

An adverse event does not necessarily mean that a mistake was made. It means that something didn’t turn out as we would have liked. It can happen when a practitioner does everything right. The more we know about what happened, the more we can confront and minimize the risks involved in treatment.

But we can’t know what happened without collecting the data. And we can’t collect the data if 1) there is no mechanism to report adverse events and 2) people are afraid to share about and discuss adverse events.

Until recently, no acupuncture organizations have been interested in collecting such data. Alarmingly, in the name of acupuncture safety, one shadowy acupuncture group has created what it calls an Adverse Event Reporting system for the sole purpose of weaponizing reports of adverse events related to dry needling. The data are not anonymous. (The board of the group collecting the data is.) The goal is not to improve the safety of a practice, but to attack competitors. It makes it more difficult to develop a culture of safety.

Finally, we have the opportunity to participate in a voluntary and anonymous database for reporting adverse events in acupuncture, developed with the goal of promoting safety.

Some questions and answers from POCA’s materials about the AERD they created –

Why Should All LAcs Voluntarily Report Adverse Events and Errors?

POCA created this AERD for ourselves but it is designed to be used by anyone who provides acupuncture services and anyone who is a consumer of acupuncture services. We are hoping that many L.Acs will participate, and that other acupuncture school clinics will want to join us in collecting safety data.

Using a voluntary and anonymous AERD is a way for the acupuncture profession to encourage a culture of safety. AERDs are standard in other healthcare professions and it is notable that the acupuncture profession has not had one; that’s a problem that needs to be fixed, especially in light of acupuncturists’ practicing in integrative medical settings.

Why Did the POCA Cooperative Create an AERD?

POCA loves data, and collecting our own safety data has been a topic of discussion in the co-op for years. Having POCA Tech as a resource to manage an Adverse Events Reporting Database, along with getting support from Dr. Suzanne Morrissey (medical anthropologist and professor of anthropology at Whitman College), allowed us to make an AERD a reality.

Why Voluntary and Anonymous?

Research suggests that it’s possible to collect better safety data, and thus do a better job of improving safety practices, when reporting adverse events and errors is voluntary and anonymous. Nonconfidential and mandatory reporting systems may discourage practitioners from disclosing adverse events and errors.

The goal is to focus on safety practices and systems, not on errors made by individuals.

Additionally, membership in POCA provides many excellent perks, whether you provide community acupuncture or not. I encourage you to check it out. Thank you, POCA, for establishing the AERD, and Lisa Rohleder, for starting this discussion. This post borrows heavily from her writing. Any errors, however, are mine alone.

7 thoughts on “Safety: Dry Needling and Acupuncture”

At the recent CCAOM conference it was announced that infections are now the number one source of acupuncture malpractice suits. That’s not surprising. In all the decades I have attended continuing education events, I have only rarely seen clean needle technique followed during the needling demonstrations. Even on YouTube, where such demonstrations are meant to be consumed by the general public, the rules of the CNT manual are routinely flouted. And the worst offenders are often the elders of the profession, the people who are seen as role models and leaders. The result is that far too many acupuncturists see clean needle technique as a pro forma exercise that is just for passing board tests; a meaningless modern ritual that is too much of a hassle and too non-traditional to be useful in real life practice. I like that responsible leaders are beginning to collect data on adverse events. I would like it even more if some of our leaders began to practice responsibly.

As I recall, the CNT manual isn’t entirely clear on some points – for instance, saying points should be wiped with alcohol, and then elsewhere saying that wiping with alcohol hasn’t been shown to do anything. It would certainly be helpful for people to report infections to the AERD and we could see whether there was a correlation to not wiping, for instance, and infection.

Too often I’ve seen patient’s reports of infection, shared on social media, as being dismissed.

Also, I’ve recently read some reports on social media that patients are showing a histamine reaction to a particular batch of needles. Is this happening across the country? It’s the sort of thing we should be tracking. If there is a bad batch of needles and no way to gather the data and spread the word, we could be in big trouble.

John Pirog wrote: “At the recent CCAOM conference it was announced that infections are now the number one source of acupuncture malpractice suits.” What’s that assertion based on? While it’s good to have a place where adverse events are discussed, I find it extremely frustrating that the only context in which that seems to be happening is 1) one where the audience is limited AND the presenter is selling malpractice insurance ( with no data actually provided) and 2) as Elaine mentioned, a website where the data is weaponized against PTs.

We deserve better: a neutral, open context in which the goal is to support safe practice, full stop, without any other agenda of selling anything or demonizing anybody. I attended a conference 6 months ago where it was announced, IIRC, that the number one source of malpractice suits was sexual misconduct. Did it change that fast? Is there a new trend leading to infections caused by a problem with practitioners’ technique or unsterile needles? Should we just take the AAC’s word for it, with no supporting documentation? And yes, after the presentation, I asked about getting their data for the AERD project, and I was told by the presenter that an AERD was a terrible idea.

You are very welcome! Thank you, for POCA and for creating this great thing that we should have had all along.

Is sexual misconduct even medical malpractice? It’s wrong. You can lose your license. But I’m not sure it’s malpractice, though.Certainly malpractice insurance doesn’t cover it, so it’s not much of sales pitch. I realize that’s a bit of a tangent, but I sure am curious about it.

Any any discussion of safety based on malpractice cases is pretty lame anyway, even if they had the data to back up whatever they say. How many times do people faint during treatment versus how often that becomes a malpractice claim? What about “healing reactions” – we may call it that, but what if the patient disagrees. Are they going to sue for malpractice?

And I heard that the number one cause of malpractice claims was burns from heat lamps. So, already we’ve got three stories…..

AERD is a terrific idea. Many mainstream medical professions are required by law to report adverse events. Reports for CA facilities can be found on the state OSHPD website. Accountability is a good thing. If acupuncture ever becomes a mainstream occupation those LAcs who report to AERD will have a head start on what for most will be a jarring even counter-intuitive – yet mandatory – practice.

Mainstreaming acupuncture keeps moving forward ever so “patinetly.” Seems inevitable. ASA has posted its “successful” negotiation (from the sidelines) with the AMA CPT committee to approve a trigger point code for dry needling. The AOM negotiators claim success. They also claim the new trigger point code will reimburse at a lower rate than the acu codes.

As POCA advances the cause for mainstream conventions ASA further marginalizes acupuncture. Dry needling is an opportunity to build collaboration with two professional groups with whom acupuncture should align. Dry needling lawsuits have been a complete failure for the regressive AOM groups. With the new trigger point code the opportunity to work together with PTs and DCs for mutual benefit has shrunk.

I, too, was confused by the celebration of the lower reimbursement rate for dry needling as a win. It seems that devaluing the insertion of a needle is considered a good thing if it seems as though it will disproportionately harm a “competitor.” And I was further saddened when a very reasonable discussion of this action on social media was met with a comment along the lines of “all we should be hearing is praise.”

The likelihood the trigger point code reimburses below the acu codes is unsubstantiated as the “negotiator” group states. IMO this is a device to build “praise” for a group that claims to represent all LAcs. These matters are political. The PTs and DCs hold the high ground here. These are well organized professional orgs. They know who will make the reimbursement decisions.